INTRODUCTIONThis study investigates the knowledge, attitudes and practices of residents in a residential estate in Singapore on the Advance Medical Directive (AMD).

MATERIALS AND METHODSA community-based cross-sectional study was conducted with residents in the residential estate of Toa Payoh Lorong 6, Singapore. A stratifi ed random sampling was conducted to obtain a representative sample of the estate. Only residents aged 21 years and older were included. An interviewer-administered questionnaire was conducted, and only those who understood the AMD suffi ciently were further evaluated on their knowledge, attitudes and practices.

RESULTSA total of 414 residents were enrolled (50.1% response rate). Only 37.9% of the participants knew about the AMD prior to this study. Participants who had a higher knowledge level of AMD, did not wish "for an artifi cially prolonged life", "to be kept alive indefi nitely on a life-support machine", wished to "lessen the fi nancial burden of loved ones", "avoid prolonged suffering" and accepted the "imminence of death" were more willing to sign an AMD. However, "religious beliefs", "personal ethical views", "dissuasion by family members" and "unclear terminology in the AMD" discouraged the participants from signing an AMD. After adjusting for signifi cant factors, participants who did not wish "to be kept alive indefi nitely on a life-support machine" and accepted the "imminence of death" were found to correlate signifi cantly with the willingness to sign an AMD [Prevalence Rate Ratio (PRR) = 2.050 [1.140-3.685], P = 0.016; PRR = 2.669 [1.449-4.917], P = 0.02, respectively].

CONCLUSIONSThere is a need to increase awareness on the AMD. Public education methods can be improved to inform residents on the implications of the AMD.